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Original Investigation | SURGICAL CARE OF THE AGING POPULATION

Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients:  A Prospective Analysis

Bellal Joseph, MD1; Viraj Pandit, MD1; Bardiya Zangbar, MD1; Narong Kulvatunyou, MD1; Ammar Hashmi, MD1; Donald J. Green, MD1; Terence O’Keeffe, MB, ChB1; Andrew Tang, MD1; Gary Vercruysse, MD1; Mindy J. Fain, MD1; Randall S. Friese, MD1; Peter Rhee, MD1
[+] Author Affiliations
1Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
JAMA Surg. 2014;149(8):766-772. doi:10.1001/jamasurg.2014.296.
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Importance  The Frailty Index (FI) is a known predictor of adverse outcomes in geriatric patients. The usefulness of the FI as an outcome measure in geriatric trauma patients is unknown.

Objective  To assess the usefulness of the FI as an effective assessment tool in predicting adverse outcomes in geriatric trauma patients.

Design, Setting, and Participants  A 2-year (June 2011 to February 2013) prospective cohort study at a level I trauma center at the University of Arizona. We prospectively measured frailty in all geriatric trauma patients. Geriatric patients were defined as those 65 years or older. The FI was calculated using 50 preadmission frailty variables. Frailty in patients was defined by an FI of 0.25 or higher.

Main Outcomes and Measures  The primary outcome measure was in-hospital complications. The secondary outcome measure was adverse discharge disposition. In-hospital complications were defined as cardiac, pulmonary, infectious, hematologic, renal, and reoperation. Adverse discharge disposition was defined as discharge to a skilled nursing facility or in-hospital mortality. Multivariate logistic regression was used to assess the relationship between the FI and outcomes.

Results  In total, 250 patients were enrolled, with a mean (SD) age of 77.9 (8.1) years, median Injury Severity Score of 15 (range, 9-18), median Glasgow Coma Scale score of 15 (range, 12-15), and mean (SD) FI of 0.21 (0.10). Forty-four percent (n = 110) of patients had frailty. Patients with frailty were more likely to have in-hospital complications (odds ratio, 2.5; 95% CI, 1.5-6.0; P = .001) and adverse discharge disposition (odds ratio, 1.6; 95% CI, 1.1-2.4; P = .001). The mortality rate was 2.0% (n = 5), and all patients who died had frailty.

Conclusions and Relevance  The FI is an independent predictor of in-hospital complications and adverse discharge disposition in geriatric trauma patients. This index should be used as a clinical tool for risk stratification in this patient group.

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Algorithm for Patient Inclusion in the Study

In total, 250 consecutive geriatric trauma patients were prospectively enrolled, 44.0% (n = 110) of whom had frailty.

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